The Aerodigestive Program at Nemours Children’s Hospital provides diagnostic and treatment expertise for children of Central Florida with problems involving the upper portions of the airway or digestive tract. The program provides support, education and long-term care for your child today and throughout future growth and development. The physicians in the Aerodigestive Program work together to minimize the number of tests, exposures to radiation (such as X-rays and CT scans) and anesthesia that are required to gather the information necessary to reach an accurate diagnosis and plan treatment.

The Nemours Aerodigestive Program includes specialists from otolaryngology (also called ear, nose and throat or “ENT”), pulmonology, gastroenterology and general surgery. In addition to the doctors listed above, your child’s care team members may include speech language pathologists, dietitians and other care team members.

Specialized Care for Aerodigestive Tract Disorders

The Aerodigestive Program at Nemours Children’s Hospital in Orlando includes physicians, advanced registered nurse practitioners (ARNPs) and physician assistants (PAs) and other specialists who have special training in aerodigestive disorders. Because we understand the physical, social and emotional impact a complex medical condition can have on a child during growth and development, we work to restore function and preserve the confidence and happiness that every child deserves.

Aerodigestive Tract Disorders We Treat

At Nemours Children’s Hospital, we treat nearly every aerodigestive tract disorder from mild to extremely complex cases, including, but not limited to:

abnormal connection of the windpipe with the esophagus (tracheoesophageal fistula or TEF)

weakness or malformation of the larynx (laryngomalacia), trachea (tracheomalacia) or airways branching to and in the lungs (bronchomalacia)

A Team Approach to Your Child’s Care

To give your child the very best treatment, our expert pediatric surgical and medical doctors work together as a team with any other specialists who may be involved in your child’s care. We also work closely with the nursing and anesthesiology teams, so everyone involved is well informed on your child’s behalf. Throughout your child’s care, we count on you as an important member of the team, because no one knows your child better than you do. We know that can be stressful, so we take steps to make sure you and your child understand what’s going on every step of the way — and that you’re coping with all of the emotions and stresses you may be feeling.

In addition to the doctors listed above, your child’s aerodigestive disorder care team may include:

Diagnosing and Treating Pediatric Aerodigestive Tract Disorders

Your child’s evaluation in the Aerodigestive Program will begin with a diagnostic appointment with one of our pediatric experts in aerodigestive tract disorders and other team members as needed. We can often make a diagnosis at the time of the initial evaluation, but depending on your child’s symptoms and condition, we may recommend additional diagnostic testing (often the same day) and schedule further evaluation with other pediatric specialists — with appointments in days, not weeks.

While most conditions can be diagnosed by a physical examination, we may need to order additional tests, including:

bronchoscopy (check for airway problems)

CT scans (computed axial tomography, also called CAT scans)

endoscopy (our experts will coordinate so that your child only needs anesthesia one time)

molecular tests (genetic makeup)

MRI (magnetic resonance imaging)

sleep studies (obstructive sleep apnea)

speech and swallowing evaluations

X-rays of the head, neck, chest and abdomen

Treatments for Pediatric Aerodigestive Tract Disorders

At Nemours, we take a conservative approach to treating aerodigestive tract disorders in children, and because every child is different, our treatment plans are individualized. Treatments may include close follow-up (watchful waiting as your infant grows) or rehabilitation therapies (speech/feeding and swallowing and others). When surgery is necessary to correct and protect physical form and function, we can perform a wide variety of procedures on even the tiniest newborns. You can trust that we’ll take the time to help you understand the different options, risks and expected outcomes.

Some of the procedures we perform to help kids with aerodigestive tract disorders are:

Laryngeotracheal reconstruction (LTR): Laryngeotracheal reconstruction may be needed due to laryngeal or tracheal stenosis or blockage. In rare cases, severe thinning or weakness of the trachea, which is called tracheomalacia, may develop after tracheostomy.

LTR increases the size of the airway by splitting the narrowed segment of cartilage rings and using cartilage grafts to increase the diameter of the trachea. Most grafts are made of cartilage taken from the ear, rib or thyroid cartilage. This graft is held in place by a plastic tube called a stent; this stent is often a breathing tube (endotracheal tube) placed into the airway during the surgery and removed several days after surgery. Successful LTR allows the removal of a tracheotomy tube, if one has been necessary to maintain an airway.

LTR can be performed one of two ways, in a single stage surgery (ssLTR), or in a double stage surgery (dsLTR). With either technique, follow-up after discharge from the hospital is required to determine whether the graft is healing and to see whether a kind of scarring called granulation tissue is narrowing the airway. If granulation tissue forms, another visit to the operating room may be required for examination of the granulation tissue under anesthesia.

Single Stage LTR: If your child has a tracheostomy tube, it will be removed during the surgery and the hole (or stoma) will be closed. There will be a cut in the neck where the surgery was done. A small drain will be placed in the neck to collect fluid and air after the surgery. If rib cartilage is used, there will be a small cut on the chest with a drain in place there, too. A breathing tube will remain in the nose after the surgery. The breathing tube keeps the airway open and supports the graft while the tissues heal so the airway does not shrink. Your child’s ENT doctor will decide how long the breathing tube and drains stay in place.

Double Stage LTR: In a double staged procedure (dsLTR), the tracheostomy tube will stay in place. The hole (stoma) may be moved during the procedure. There will be a cut in the neck where the surgery was done. A small drain will be placed in the neck to collect fluid and air after the surgery. If rib cartilage is used, there will be a small cut on the chest with a drain in place there too. A stent may be placed in the airway to support the graft. Your child’s ENT doctor will decide how long the stent and drains stay in place.

Convenient Care and Support for the Entire Family

Dealing with a chronic or complex medical condition is difficult for your child and family, but you don’t have to go through it alone. Nemours Children’s Hospital provides an array of support services that begin on the very first day we meet, and continues throughout your journey.

Some of the very same surgeons, gastroenterologists and nutritionists you may see at Nemours Children’s Hospital also provide follow-up appointments at our convenient Central Florida specialty care locations in downtown Orlando, Lake Mary and Melbourne.

Your child and your family are very important to us, but our work doesn’t stop there. We maintain extensive research efforts to find better ways to treat all the health challenges — from common problems like gastroesophageal reflux disease (GERD) to complex aerodigestive tract disorders — challenges that kids all over the world have to face. Clinical trials help determine which treatment works best, and the knowledge gained from these studies is published, so the information helps kids all over the world (and their families too).

Because we truly believe in family-centered care, we invite you (one parent or guardian) to the operating room to be with your child until just after sedation. We also provide our families with a peaceful place to wait without leaving the surgical floor, in our beautiful rooftop garden.

After Tracheal Reconstruction or Other Major Surgery

After tracheal reconstruction or other major surgery, your child will be cared for and closely watched in the pediatric intensive care unit (PICU). Medicine will be given to your child to reduce the chance of accidental removal of the breathing tube, which helps protect the airway as it heals.

The surgical team may return your child to the operating room for laryngoscopy and bronchoscopy (DLB) to see how well the airway is healing. After the breathing tube is removed, your child’s breathing will be monitored. When the medicines that induce relaxation are stopped, some children may feel or appear shaky for a short period of time.

A Hospital Designed by Families, for Families

At Nemours Children’s Hospital, family-centered care is at the heart of everything we do. In fact, families helped shape the unique amenities and convenient services that make our hospital like no other in the region.

If Your Child Needs to Stay Overnight in Our Hospital

You’ll feel right at home in one of our private patient rooms designed with input from families who know what it’s like to have a child in the hospital.

Our large, comfortable, single-patient rooms have sleeping accommodations for two parents, a private bathroom, wireless Internet access, connections for DVD players and game systems, and two flat-screen TVs.

Other in-room features include:

full floor-to-ceiling windows for natural light

refrigerator for family meals and snacks

wardrobe storage for personal items and a hotel-style safe

GetWellNetwork interactive television (uniquely based on your child’s age, medical condition and more) and allows your child to watch TV, surf the Web, check e-mail, play music and games, and learn about your Nemours health care team.

Our “hospital within a garden” setting features many places for you and your family to go for fresh air and relaxation, including a one-acre interactive sensory discovery garden or one of our rooftop gardens on the second and fourth floors.

If your child needs medical imaging, we offer some of the area’s most advanced pediatric radiology services here on campus at Nemours
Children’s Hospital.

Our unique services include:

interventional radiology: Our team of experts uses image guidance to diagnose and treat diseases and tumors throughout the body. Certain conditions that previously required open surgery can now be treated by Nemours pediatric interventional radiologists. We are very fortunate to have the only dual-trained pediatric diagnostic and interventional radiologist in the state.

Central Florida’s only 256-slice Brilliance iCT Scanner: We are one of only a handful of children’s hospitals in the country to have this latest generation CAT (or CT) scanner that scans faster than most machines and produces excellent images in a much shorter time with much less radiation exposure for the child.

Our team of board-certified pediatric radiologists and pediatric radiologic technologists are experts in the safe medical imaging of children of every age, even newborns.

We have also pledged our commitment to the “Image Gently” campaign of the Alliance for Radiation Safety in Pediatric Imaging, which is increasing awareness of the opportunities to promote radiation protection in the imaging of children.

At Nemours, we want to hear your concerns and share with you everything we can about your child's condition and treatment. If English is not your first language, we'll make sure you understand what to expect — in your language.